Insured Nomads - Group Travel Quote Request

Thank you for your interest in Insured Nomads' Group Travel Insurance Plans!
The initial quote provided is a general estimate based on the basic details submitted through this form.
For a more accurate and personalized quote, please gather the information for listed below and either attach it to this form or send it to us separately via email.

For ALL TRAVELERS: DOB & Age, Passport Country, Gender

For the Policy: Deductible, Medical Maximum, Add-Ons, Trip Cost (Trip Protection Plan Only)

View Brochures Here

Group Travel Quote Request

Company Details

Primary Email*

First Name*

Last Name*

Company Name

Are you representing a Company? Complete this field with your Company Name. Or, if you are doing business as an Individual, then leave this field blank.

Primary Phone

Title

Website

Address Line 1*

Address Line 2

City*

ZIP / Postal Code*

Country*

State / Province*

Travel & Insurance Details

Will any travelers be traveling to Belarus, Burma, Cote D'Ivoire, Cuba, the Democratic Republic of Congo, Russia, Iran, Iraq, Liberia, North Korea, Sudan, Syria, Ukraine, or Zimbabwe.*

Date Signed:*

When is your expected Policy End Date?*

What is the primary Passport Country of most of your travelers?*

Where is the Initial or Primary Destination/Country?*

Which Travel Insurance Plan do you need for your group?*

Guardian Plans are currently only available for US citizens and residents.

How many people do you want insured? (add all employees, dependents, guests, etc.)*

Please select your deductible (in USD):

Please select your Maximum Medical Benefit (in USD):*

Would you like the plan to include or exclude travel to the United States?*

Exclude US

Include US

Would you like to include any additional benefits?*

How many maximum days per trip would you like?*

Please Note: For the Multi plans the deductible is set at $250 and the medical maximum benefit is set at $1 million.

Which Guardian Plan would you like quoted?*

Are all travelers US residents or citizens?*

Yes

What state or states are travelers residents of? Please list it here or include it in the census.

All travelers must have health insurance in their own country. Do all travelers have health insurance in their home country?*

Yes

What is the trip cost for each traveler (or include separately in the census)?*

What deductible would you like quoted (in USD)?*

Would you like to quote any additional benefits?*

Would you like to quote with the Adventure Sports additional benefit?*

Yes

Please upload any supporting documents here:

Thank you for filling out this form. Our team will be in touch with you shortly!
In the meantime, please don't hesitate to reach out to members@insurednomads.com with any additional questions.